What it means to be well

What is being well?

What it means to be ‘well’ changes with geography, culture and also time. Historically, notions of wellness and illness have been influenced by a society’s medical system, religious beliefs and cultural values. As a result, what has been considered a ‘normal’ versus ‘abnormal’ physical experience has often changed. Today, the presence of continuous and severe pain is considered abnormal - if we start to feel a sharp, persistent ache in our side, we will usually get ourselves to a doctor within a couple of days. In earlier times, however, the presence of physical pain was often a reality of daily life.

Samuel Pepys’s complaints

Samuel Pepys.

In the late 1600s, for example, the London naval administrator Samuel Pepys wrote in his diary about all the different pains that plagued him. Colds, failing eyesight and pain from bladder and kidney stones were a constant presence in his life, but he visited a doctor relatively rarely. He saw his conditions as something to be managed and lived with rather than cured. Being ‘well’ for Pepys meant being able to carry on with work and other daily activities, and this standard applied to most people living and working in England at this time.

When do we become ill?

In Pepys’s time, wellness was usually considered the ability to keep working, and a sense of real illness or incapacity resulted only when labour could no longer be performed. Though medicine has changed quite a bit since Pepys was alive, this issue of the cost of illness - that is, the financial burden it creates - remains a problem for many people.

In the United States, where the government does not offer universal health coverage, nearly one-sixth of the population have no medical insurance at any given time. Because of this, many people cannot ‘afford’ to be ill, and so they keep working as long as they are physically and mentally able - often complicating existing health problems.

Another factor influencing ideas about illness today is the disease categories that biomedicine and medical insurers acknowledge. If an individual’s symptoms cannot be fitted into a particular disease category, insurers may refuse to fund treatment. A specific diagnosis from a doctor confirms a patient’s status as ‘ill’ - without this official recognition, a patient’s experience of discomfort and illness may not be taken as seriously.

Changing ideas about epilepsy

In addition to health issues such as the experience of chronic pain, conceptions of particular diseases and disabilities also change based on time and place. Epilepsy is one of the clearest examples of how cultural beliefs can influence people’s views of certain conditions. In ancient Greece, epilepsy was often referred to as the ‘sacred disease’, since many people believed that supernatural influences caused an epileptic’s seizures. Several writers suggested that the condition was a punishment for sin and could be contagious, and as a result sufferers of epilepsy often found themselves subjects of public scorn.

Similarly, in traditional Hmong culture, epilepsy has long been viewed as a form of spiritual possession (the Hmong are an ethnic group originally from southern China). The spirit involved, known as a dab, temporarily traps a person’s soul and makes him or her sick with seizures and pains. Though the Hmong believe the spirit to be malevolent, they also view the condition as special, since it allows the sufferer a closer connection with the spiritual world. As a result, many epileptics in the Hmong culture have become shamans, which are like priests, and have enjoyed a high level of respect from the society in which they live.

What counts as a disability?

Abbot de L'Epee, with the French sign language alphabet.

Personal and social meanings attached to a disability can also vary dramatically over time. The experience of being deaf, for example, has been largely shaped by differing cultural values and medical knowledge. In the ancient Hebrew and Roman world, the rights of the deaf were often restricted because of beliefs that they were unteachable and therefore incapable of developing intellectually. Though the philosopher Socrates noted that some deaf people seemed to communicate via signs, it was not until the 1600s that structured sign languages and ideas about deaf education started to be taken seriously.

Large-scale efforts to create deaf schools in the 1700s meant that many deaf children no longer grew up in isolation, and deaf individuals began forming tight-knit communities. Today, many deaf people identify as a cultural group, and controversies have arisen as to whether not being able to hear should be considered a disability at all. Many deaf people take great pride in the expressiveness of sign languages and in the experience of being a part of the deaf community, leading some to reject medical technologies that might improve hearing ability, such as cochlear implants.

Health and cultural beliefs

Such examples illustrate how ideas about health, illness and disability are highly dependent on cultural values and beliefs. In a 1978 essay on the nature of illness, writer and critic Susan Sontag suggested that all people are ‘dual citizens’ of the land of the well and the land of the sick. ‘Although we all prefer to use only the good passport’, she wrote, ‘sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.’ What Sontag did not discuss, however, is that the terms upon which we move between the ‘kingdoms’ of wellness and illness change depending on our knowledge and belief systems. To be ‘well’ is not only a question of how the body functions - it is also a consequence of the society in which we live.